Provider Demographics
NPI:1699222059
Name:WARD, CHARA MATSUO (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARA
Middle Name:MATSUO
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 ANDORRE GLN
Mailing Address - Street 2:NONE
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-6643
Mailing Address - Country:US
Mailing Address - Phone:858-774-3751
Mailing Address - Fax:
Practice Address - Street 1:1582 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:760-410-8021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS264911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical